Individual
MARK LANDT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
37 ELK PLACE, EDWARDS, CO 81632-0722
(970) 926-5702
Mailing address
PO BOX 722, EDWARDS, CO 81632-0722
(970) 926-5702
(970) 926-5702
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
34-00-3644
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000024299
ANTHEM PIN#
OH
01
—
050045148
TRAVELERS PIN#
OH
05
—
0553995
—
OH
01
—
20-00775
UNHC PIN#
OH
Enumeration date
06/14/2005
Last updated
03/20/2015
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